Breast cancer screening reduces mortality by half in childhood cancer survivors
USA: Survivors of childhood cancer treated with chest radiography may strongly benefit from early initiation of annual breast cancer screening with MRI in their 20s, a recent study has found. According to the study, published in the journal Annals of Internal Medicine, the cancer screening with or without mammography might reduce the mortality from breast cancer by half or more.
Female survivors of childhood cancer treated with chest radiation are recommended to undergo surveillance with breast magnetic resonance imaging (MRI) and annual mammography. Yet, its benefits, harms, and costs are uncertain.
Jennifer M. Yeh, Harvard Medical School and Boston Children's Hospital, Boston, Massachusetts, and colleagues set out to compare the benefits, harms, and cost-effectiveness of breast cancer screening strategies in childhood cancer survivors.
The authors used two well-researched breast cancer simulation models. Theyadjuste d the models for their specific population, then calculated the benefits and harms of performing breast screening with different modalities and starting ages. Women aged 20 years with a history of chest radiotherapy were included. They were exposed to annual MRI with or without mammography, starting at age 25, 30, or 35 years. The outcome measures were breast cancer deaths averted, false-positive screening results, benign biopsy results, and incremental cost-effectiveness ratios (ICERs).
Key findings of the study include:
- Lifetime breast cancer mortality risk without screening was 10% to 11% across models.
- Compared with no screening, starting at age 25 years, annual mammography with MRI averted the most deaths (56% to 71%) and annual MRI (without mammography) averted 56% to 62%.
- Both strategies had the most screening tests, false-positive screening results, and benign biopsy results.
- For an ICER threshold of less than $100 000 per quality-adjusted life-year gained, screening beginning at age 30 years was preferred.
- Assuming lower screening performance, the benefit of adding mammography to MRI increased in both models, although the conclusions about preferred starting age remained unchanged.
"Early initiation (at ages 25 to 30 years) of annual breast cancer screening with MRI, with or without mammography, might reduce breast cancer mortality by half or more in survivors of childhood cancer," concluded the authors.
The study, "Clinical Benefits, Harms, and Cost-Effectiveness of Breast Cancer Screening for Survivors of Childhood Cancer Treated With Chest Radiation," is published in the journal Annals of Internal Medicine.